Four weeks on, the floods that descended on Pakistan’s north-west, have engulfed the entire length of the country. All along the increasingly ferocious Indus, large chunks of land in southern Punjab, Sindh and Baluchistan are submerged in water, destroying crops, homes and livestock, forcing the inhabitants of several villages to migrate to drier land. These internally displaced persons (“IDPs”), refugees in a sense, are in urgent need of shelter, food, clean water and medical attention.

This is not the first time that Pakistan has had to provide for large numbers of refugees. During the Soviet occupation of Afghanistan, in excess of three million Afghan refugees fled to Pakistan. More recently, during the Swat offensive last summer, IDPs vacated their homes, moved in with relatives or took shelter in camps and tent cities while the army battled it out with the Taliban. Yet Swat was different. The numbers involved were small. The area affected was geographically containable and the damage to private property bearable.

This time, 20 million people are affected by the floods. One-fifth of the country washed away. In Swat alone, nearly all the bridges have been destroyed. All roads to Baluchistan, with the exception of one, are unreachable. And there was no time for preparation. No time to erect tent cities or camps to which the IDPs could be directed. Many camped on rooftops or levees hoping the water would be merciful. But there was no such luck. Although major cities are intact, innumerable villages are inundated, causing the IDPs to make their way to the cities. They camp wherever they find space.

Doctors from the Pakistan Medical Association are trying to cope with the human tragedy. Setting out into the field, Dr. Nighat Shah writes in her diary (forwarded to me by email) from Khairpur, Sindh: “Khairpur, at this moment, is housing a huge bulk of displaced people from Larkana, Jacobabad, Shikarpur and many smaller villages….the registered displaced people are more than 50,000. Around 120 camps are housing people in small clusters. These range from 250-300 people in smaller schools, to 5000-8000 in bigger schools.”

With tents in very short supply, public schools are being substituted as IDP camps. Their toilet facilities clogged, furniture falling into disrepair, several educational facilities are indefinitely closed. If more tent villages can be set up, Dr. Nabil Zafar, another doctor in the field notes, “at least not all of the desks will become firewood.” Yet the children deprived of an education are not of primary concern. It is the enormous number of children suffering from disease and malnutrition that is a far greater worry.

Dr. Nighat Shah writes, “In all camps, by far the majority is of children….Almost all the children are sick, ranging from stunted growth, severe malnourishment, diarrhoea and skin problems. The women are almost all anaemic, weak, malnourished, perpetually pregnant or breast-feeding. The sad part is there is no milk but the baby is still latched.”

Khairpur, with all its troubles, is still better off than other areas like Dera Ismail Khan, where 800,000 people are displaced and 150 villages affected, not to mention the 400,000 IDPs from adjacent Waziristan that are still there, having evacuated their homes prior to the recent army action against insurgents in their area. With infrastructure and hospitals severely damaged, even NGOs are largely absent from this area.

And in the mountains, places like Gilgit-Baltistan and Kohistan have become completely inaccessible. As the people of this area tend to be as rugged as their terrain, they have industriously replaced fallen bridges with make-shift arrangements. But the substitutes are treacherous and difficult for urban NGO-types to negotiate. In an interview on Aaj TV, the program director of the only NGO that has ventured there revealed that when his workers crossed the bridge to deliver food to those unfortunate ones who had been cut off from the world, they came back drenched in sweat. Their sweat was not from the heat as the mountains remain cool in summer, but from sheer fear and dread of the flimsy and inadequate improvised bridge on which they walked. Underneath it, flowed torrential waters, ruthless in their carnage. What if the bridge gave way? Eventually, it did. The victims: a pregnant woman and her three children.

Although not many lives have been lost, long treks and 13 hours of trudging through waist-deep water has resulted in separated families. One seven-year old lost girl in Sindh took refuge at a Sikh temple, a gurdwara, until Dunya TV crews discovered her. Although her information was broadcast, it is doubtful her family is able to view television in the camp where they may have sought refuge. Meanwhile, at the gurdwara, multi-religious communities come together to help each other out of their misery and feed the IDPs that have camped around it. Chanting “Hindu, Sikh, Muslim, Essai, bhai bhai,” (Hindus, Muslims, Sikhs and Christians are all brothers) local people try to aid each other.

But international aid is slow to arrive. For those who have lost their homes and their crops, the loss of their farm animals is the most difficult to bear. A seventy-year old woman in south Punjab refuses to vacate her home unless her goat is also evacuated. In another instance, a navy boat rescuing a group from a severely affected area is made to turn back so that “their children,” as the IDPs put it, can also be saved. As it turns out, the children are cattle and sheep and there is no room for them on the boat.

With transportation and communication links severely disrupted, identity cards washed away, and resources scarce, relief efforts are overburdened. As Faris Kasim, working in the field with Save the Children, emailed, “Collecting data, coordinating and responding to the crisis and even receiving information has been quite challenging. We have barely slept coordinating with the government, army, National Disaster Management Authority and UN agencies to organise relief…I guarantee you, as an eye witness to the disaster, that everyone is working round the clock to help the affected people…the emergency response has been far better than what we saw during the earthquake in 2005 or the floods in 2007.”

Yet the scale of the disaster is so large, the number of people affected, according to a report by the Brookings Institution, is more than three times that of Haiti’s earthquake and more than ten times that of Hurricane Katrina. A catastrophe of this magnitude is impossible to manage without a lot more help from the international community.

AYESHA IJAZ KHAN is a lawyer and political analyst. She can be reached through her website: www.ayeshaijazkhan.com